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BOOKS
Reviews
Clinical Neuropsychology, ed 3
Edited by Kenneth M . Heilman and Edward Valenstein
New York, Oxford University, I993
726 pp, illustrated, $65.00
This is the third edition of a classic book. It is, without question, the most important source for detailed descriptions of
the classical syndromes. Several chapters contained in the last
edition are significantly revised, especially when authorship
changed. Other chapters have been thoughtfully updated,
reflecting advances in the 8 years since the second edition.
A few chapters, unfortunately, are not significantly updated,
and this is probably the major flaw.
The book has a solid, encyclopedic feel, rather than the
sense of a book on the forefront of neuroscience, so it lacks
some of the impact of the original 1979 edition. The third
edition also serves to show that clinical neuroscience expectations are different in the mid 1990s versus the late 1970s.
Some chapters are at the cutting edge, while others lag badly
behind, so this edition is more variable than the uniform
excellence of past editions.
Most chapters continue to couple a description of the key
features of each syndrome with a description of anatomical
correlates. More chapters than in the past also present conceptual models to organize what are otherwise interesting
but isolated facts about specific syndromes. However, the
emphasis remains on autopsy or computed tomographic scan
findings, with remarkably little input from the magnetic resonance imaging (MRI) era, almost no input regarding functional imaging modalities, or discussion of possible neurochemical correlates.
The revised Introduction by the co-editors is a superb essay on clinical neuropsychology. The chapters on alexia by
Friedman, Ween, and Albert, on apraxia by Heilman and
Rothi, and o n visuoperceptual and related disorders by Benton and Tranel are all heavily influenced by cognitive psychology. The chapter by Damasio and Anderson on frontal lobes
is significantly redone, with a very current review of MRI
findings, but lacks organizing concepts such as models of
interactions among various frontal lobe regions or functions.
Probably the best chapter revision is on agnosia, by Bauer.
H e gets beyond the “gee whit” aspects of the syndrome to
provide coherent categorization and classification. In addition, he explores alternative models to explain phenomena
and to test competing hypotheses. There is a particularly
interesting review of the recent literature on agnosia and
conscious awareness that has broad application for understanding “overt” versus “covert” processing in many areas of
cognition, and is well connected to neural processing. A close
second for excellence is the newly added chapter on schizophrenia by Randolph, Goldberg, and Weinberger, emphasizing clinical issues, competing hypotheses, and directions for
future progress.
The chapter on dementia, newly written by Whitehouse,
Lerner, and Hedera, is the most disappointing. The chapter
is little more than a recital of the variety of neurological
syndromes that can present as dementia. The literature on
416
neuropsychological studies of cognitive breakdowns was totally neglected in this chapter.
With a few exceptions this book continues to be a key
resource. If you already have the first or second edition,
consider carefully whether the current revisions merit purchase. O n the other hand, if you missed the previous editions, you should most definitely acquire the third.
John A. Walker, PhD
San Francisco, CA
Brain Lesions in the Newborn:
Hypoxic and Hemodynamic Pathogenesis
Edited by Hans C. Lou, Gomz Greisen,
andjorgen Falck Larsen
Copenhagen, Munkrgaard, 1994
SO8 pp, illustrated
This book is a collection of presentations from the recent
37th Benzon Symposium in Denmark. This meeting assembled an international panel of investigators from a broad spectrum of disciplines (including obstetricians, neonatologists,
neurologists, neuroscientists, and neuroradiologists) to focus
on progress in the diagnosis, management, and prevention
of fetal and neonatal brain injury, the specific focus being on
“hypoxic and haemodynamic” mechanisms of such injury.
Over the past two decades, the complex field of neonatal
cerebrovascular disease has seen both major advances and
continued controversy. Most of the major contributors in
this field are included in the list of participants.
The book covers a broad expanse of subjects relating to
perinatal-neonatal brain injury, including sections on brain
development (cytogenesis, migration), environmental and
maternal-placental risk factors for fetal brain injury, the timing of brain injury (using epidemiological, pathological, magnetic resonance imaging, and continuous cranial ultrasound
data), fetal behavior patterns (normal and abnormal), cerebral
hemodynamic regulation (normal and postasphyxia), thresholds for hypoxic-ischemic injury, mechanisms of injury with
an emphasis o n the excitotoxic mechanisms, diagnostic techniques (including magnetic resonance, near infrared spectroscopy, evoked potentials, and fetal behavior monitoring), and
pharmacologic intervention.
The book‘s strongest sections include comprehensive reviews of hemodynamic control, ranging from placental-fetal
to neonatal cerebral blood flow regulation; reviews of hypoxic-ischemic thresholds and the role of excitatory amino
acids in brain development and injury were particularly lucid.
This project might be faulted for being overambitious in
its attempt to cover such a broad landscape. In addition, the
wide range of topics covered would benefit from a more
organized presentation; currently, there is little logic to the
sequence of chapters. Collecting related presentations into
specific sections would have made this book more approachable. In addition, the relevance of a number of presentations
to a book focusing on the hypoxic and hemodynamic mechanisms of neonatal brain injury is not always made clear. Specifically, the early chapters dealing with brain development
fail to emphasize the potential (and controversial) role of
Copyright 0 1095 by the American Neurological Association